In Safdar v General Medical Council [2025] EWHC 3176 (Admin), the High Court dismissed an appeal against the decision of a Medical Practitioners Tribunal to impose a sanction of erasure, having found the Appellant Doctor’s fitness to practise impaired by reason of serious misconduct. Whilst the judgment does not really break new ground, it does provide a helpful summary of existing key principles, and provides a helpful illustration of how a Tribunal can assess insight without falling foul of the requirement to not equate maintenance of innocence with lack of insight.

The Background

Some of the background facts of this matter are a mystery; owing to the High Court having made an anonymity, reporting restriction and third-party non-disclosure order to protect the identity of a person identified as ‘Ms A’, and “to restrict access to sensitive information”. Despite that, the Tribunal’s findings with respect to allegations of misconduct which were found proved against Dr Safdar show that his conduct:-

1. Involved him being dishonest on more than one occasion with respect to matters concerning Ms A;
2. Was intended to benefit his position, and/or undermine Ms A’s position in (other) court proceedings.

Although Dr Safdur had made admissions to some of the facts of the allegations at the outset of the hearing, he had denied that his conduct was dishonest. The Tribunal determined that his conduct was dishonest, describing it as “deplorable”. They found that he had used his knowledge of the particular circumstances of events, together with his position as a doctor, “to paint a false picture” for his own benefit and to undermine Ms A. Whilst acknowledging that the risk of repetition was low, the Tribunal further noted “the absence of any evidence [. . .] to suggest that he has developed any insight into his wrongdoing or taken any steps toward remediation”. They concluded that the misconduct was so serious that no lesser sanction than erasure would be adequate to maintain public confidence and uphold professional standards.

The Appellant’s Submissions

Before the High Court, it was argued on Dr Safdur’s behalf that the sanction of erasure was neither necessary nor appropriate in the public interest, and was excessive and disproportionate. It was submitted that:-

1. The Tribunal had not given proper weight to the “highly unusual features” of the case;
2. The Tribunal’s conclusion that Dr Safdur did not have insight into his misconduct was wrong;
3. The risk of repetition was no more than theoretical, and the Tribunal had failed to take into account Dr Safdur’s previous history, or lack of repetition subsequent to the misconduct.

The Court’s Conclusions

In rejecting each of the above arguments, Steyn J, considered that:-

1. The Tribunal were entitled to reject the characterisation of the circumstances in which Dr Safdur found himself as being “highly unusual features”, and, in any event, such features “did not materially diminish the gravity of Dr Safdur’s conduct”, taking into account that the Tribunal had concluded that “his actions were deliberate and his motive was malicious”.
2. The Tribunal did not equate Dr Safdur’s denial of the misconduct with lack of insight, “[b]ut where the misconduct was intentional [. . .] it is very difficult to remediate, and to show that what motivated and triggered the misconduct has been identified and understood, without an acceptance that it did happen.”
3. With regards to the risk of repetition, “[t]he Tribunal’s assessment that the risk of repetition of dishonest conduct was low but could not be ruled out was reasonable and moderate in circumstances where he had not shown insight into the triggers and motivations for his misconduct”.  

Steyn J went on to conclude that “[t]he Tribunal were clearly entitled, and in my view undoubtedly correct, to decide that public confidence in the medical profession would be undermined if they imposed any lesser sanction for Dr Safdur’s very serious dishonesty than erasure.”

Key Takeaways

Whilst not establishing any particularly novel matters of principle, the Judgment does provide a helpful summary, and application, of the key principles which are relevant to the assessment of impairment and sanction in cases involving dishonesty. The Tribunal’s approach, which was endorsed by the High Court, demonstrates the importance of making a holistic assessment of any factors which they are asked to take into account, and ensuring that proper weight is given to the gravity and seriousness of the misconduct in that assessment.

More particularly, the Judgment helpfully emphasises that although Tribunals should not simply find that that a Registrant lacks insight because they have denied their misconduct, they can do so in an appropriate case. Tribunals and advocates alike should not be wary of truly grappling with what a Registrant’s denial of misconduct means in the particular circumstances of the case, and there is certainly no requirement to accept that a Registrant has insight simply because they show an “abstract understanding” that their conduct was wrong. In cases where it is found that “the misconduct was intentional”, denial of that misconduct will undoubtedly be a highly relevant factor when considering a Registrant’s insight, and should be assessed.

How Capsticks can help

Our Regulatory team has a vast amount of experience in advising on issues including impairment and sanction. We also have a large team of advocates who regularly present cases before panels, and make submissions on the proper approach to such matters.

For further information on how we can assist, please contact Louisa Atkin or any of your regular contacts at Capsticks.